Provider Demographics
NPI:1942216437
Name:ROSENTHAL, LOREN ETHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:ETHAN
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 WEST CEDAR STREET
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-454-6243
Mailing Address - Fax:845-454-6491
Practice Address - Street 1:69 WEST CEDAR STREET
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-454-6243
Practice Address - Fax:845-454-6491
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD1126842084N0400X, 2084S0012X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B80480Medicare UPIN
701921Medicare ID - Type Unspecified
WEX421Medicare ID - Type Unspecified